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The Obesity Paradox and Cardiorespiratory Fitness

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Cardiorespiratory Fitness in Cardiometabolic Diseases

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Abstract

Obesity is associated with a number of risk factors for cardiovascular diseases (CVD), such as metabolic syndrome, hyperlipidemia (HLD), glucose intolerance, and hypertension (HTN). Several studies have, however, reported that a body mass index (BMI) representing overweight and obese individuals (BMI > 25.0 kg/m2) is more protective against mortality than BMI representing normal-weight individuals (BMI 18.5–24.9 kg/m2). This association has been termed as the BMI or obesity paradox (OP). In contrast to obesity, increased cardiorespiratory fitness (CRF) is associated with lower risk for CVD. In addition, some evidence suggests that CRF may modulate the BMI-CVD association. Specifically, the increased risk observed in individuals with normal BMI levels is greatly attenuated by increased CRF, suggesting that the increased risk may be the outcome of underlying muscle-wasting disease and not low body weight per say. In this review, we discuss the effects of the OP and CRF as it pertains to morbidity/mortality and CVD, as well as the role of physical activity and CRF in modifying morbidity/mortality and CVD.

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Abbreviations

AF:

Atrial fibrillation

BMI:

Body mass index

CHD:

Coronary heart disease

CRF:

Cardiorespiratory fitness

CVD:

Cardiovascular diseases

DM2:

Diabetes mellitus

HF:

Heart failure

HLD:

Hyperlipidemia/dyslipidemia

HTN:

Hypertension

LDL-C:

Low-density lipoprotein cholesterol

METs:

Metabolic equivalent

MetS:

Metabolic syndrome

OP:

Obesity paradox

PA:

Physical activity

VO2:

Maximal oxygen uptake

WC:

Waist circumference

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Authors and Affiliations

  1. UCF/HCA Graduate Medical Education - Internal Medicine, Ocala Regional Medical Center, Ocala, FL, USA

    Michelle Phuong Nguyen

  2. Graduate Medical Education, Ocala Regional Medical Center, Ocala, FL, USA

    Sergey Kachur

  3. Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA

    Carl J. Lavie

Authors
  1. Michelle Phuong Nguyen
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  2. Sergey Kachur
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  3. Carl J. Lavie
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Correspondence to Carl J. Lavie .

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Editors and Affiliations

  1. Veterans Affairs Medical Center, Georgetown University School of Medicine, Rutgers University Department of Kinesiology and Health, University of South Carolina Arnold School of Public Health, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Peter Kokkinos

  2. Clinical Research Institute of Northern Virginia, Burke, VA, USA

    Puneet Narayan

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Nguyen, M.P., Kachur, S., Lavie, C.J. (2019). The Obesity Paradox and Cardiorespiratory Fitness. In: Kokkinos, P., Narayan, P. (eds) Cardiorespiratory Fitness in Cardiometabolic Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-04816-7_15

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